Provider Demographics
NPI:1205975331
Name:PODESTA, MINDY THERESA (CCCSLP)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:THERESA
Last Name:PODESTA
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SEAFIELD LN
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7814
Mailing Address - Country:US
Mailing Address - Phone:631-666-6138
Mailing Address - Fax:
Practice Address - Street 1:21 SEAFIELD LN
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7814
Practice Address - Country:US
Practice Address - Phone:631-666-6138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist